HomeMy WebLinkAbout006-439-31-1202-LUP-2004-494 �
Application for Land Use Permit(*Non-shoreland*) o o �
County of Sawyer � �
PO Box 676 -Haywazd WI 54843
715/634-8288 �
*Property that is not located within 300'of a creek,river or stream or within 1000'of a �
flowage,lake or pond or does not have any of the above waterbodies located within m
the property's boundaries. � '
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL �
�afhle,e�/�C,M�sI-opher �,
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Owner Buil r tlw�s��-i� g� �
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Mailing Address Mailing Address I � �
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City,State,Zip City,State,Zip �
iis 3�i /,���C ,
Daytime Phone Daytime Phon �
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Additional Information: Zone Dist�t: �lp S �GC �Y1 Q, r - "'
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LotDimensions: • 0 k /320�
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Date lot was created: ���;� �%�'�t_� Acres: ��� o �
Is there wetland near the proposed structure?If yes,how far it-�' � 4
Building Land Use Floodptain:( j Yes (Kj No �
(�New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration (tQ Grading O Private Rd (�Q Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,"', �
� ) � ) o S
Primary�tructure Accessory Fsuilding Add:tion �.��o
0
�Dwelling O Gazage-attached/detached O Deck W RC
( )Year round ( )#of caz stalls ( )Porch � �
(�Seasonal ( )Storage Building ( )Enclosed �
(}c)Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen CC�. �
( )Mobile/manufactured ( )Other ( )Bedroom � \
( )Other primazy structure ( ) ( )Relocate/enlarge '
-� � ( ) ( )#of new � �
Additional Information: p
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Type of Construction: p I`,�
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �' }_
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( )Other ,�
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Construction Cost:Primary Structure$ ��;�5 �:LC' ,�c� ` , v��f �
i rn I
Accessory Building:$ Addition:$ x �
►� 317ovy �,�i�shcv � tik. �
Deed:Vol Pg Certified Soil Test# °O z
CSM:Vol Pg Lot# Sanitary Permit# ��/- 3� '7 0, �
Plat Envelope Or: �;, �
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: " �
Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ���k-�
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Describe the construction using these wlumns.List the dimensions of each structure in a separate
column.List each story,each addition,each alteration in a separate column.
#L ��.b,,. #2. 2nd Ftco� #3. #4.
Size_�;;' _ft.wide ft.wide ft.wide ft.wide
-�4, ft.long ft.long ft.long ft.long
Floor area I 2 r�� sq.�. �'�L sq.fr. sq.ft. sq.ft.
Hgt.from g�ade "���to peak ft.hgt. ft.hgt. ft.hgt.
Stories .,� �}�:���4��`� stories stories stories
#of bedrooms ; �
_ �
1(0 � Rear Lot Line
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Fire Number and Name of Road 4'i� 1����h�" u`'��'IJ�f�i �;C� ��nq��r,✓
1. Enter lot dimensions and indicate north by arrow. Si of 0 �or�orized Agent:
2. Indicate the location and size of the requested construction
7 Signatur
aCtivitiCS. �'fl�f /�/./3 c..�
PnntName:��' cc
3. Also,lndicate the location and distance to the well, The atove ce�nfies that me iisted into�ation and intentans are
We and cortecL,that aIl work shall be performed in compliance
Sept1C tank aTld a1'ainfield,wetland areas,lot lines anQ to the with the requiremenis ot�he Sawyer Counry Zoning Ordinance
and ihe laws and regulatlons of the State of Wisconsin,and if
COriYEL�IIIC Of Y}IC LOfld. acting as ovmer(s)agent has ihe permission of the owner(s)to
pertortn the work 2quested on this applicafion. The above
persons/s hereby give permission for access to the propeRy for
onsite inspection.
Permit fee:$
September 13, 2004
Issue Date Signature ofIss i ent
September 13 ,2005 a
50/o Rule: Average Road Setback:
Expiration Date
Office Comments:
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